Beruflich Dokumente
Kultur Dokumente
Acne
by Barbara Sheen
2004 by Lucent Books. Lucent Books is an imprint of The Gale Group, Inc.,
a division of Thomson Learning, Inc.
Lucent Books and Thomson Learning are trademarks used herein under license.
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Lucent Books
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No part of this work covered by the copyright hereon may be reproduced or used in any form or by
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Table of Contents
Foreword
Introduction
A Disease That Is Often Ignored
Chapter 1
What Is Acne?
10
Chapter 2
Diagnosis and Treatment
24
Chapter 3
Alternative and Complementary Treatments
38
Chapter 4
Living with Acne
53
Chapter 5
What the Future Holds
67
Notes
Glossary
Organizations to Contact
For Further Reading
Works Consulted
Index
Picture Credits
About the Author
81
84
86
88
89
91
95
96
Foreword
The Most
Difficult Puzzles
Ever Devised
C
Foreword
has resulted in the saving of untold millions of lives. The isolation of the enzyme insulin has reversed what was once a death
sentence for anyone with diabetes. There have been great strides
in combating conditions for which there is not yet a cure, too.
Medicines can help AIDS patients live longer, diagnostic tools
such as mammography and ultrasounds can help doctors find
tumors while they are treatable, and laser surgery techniques
have made the most intricate, minute operations routine.
This toe-to-toe competition with diseases and disorders is
even more remarkable when seen in a historical continuum. An astonishing amount of progress has been made in a very short time.
Just two hundred years ago, the existence of germs as a cause of
some diseases was unknown. In fact, it was less than 150 years ago
that a British surgeon named Joseph Lister had difficulty persuading his fellow doctors that washing their hands before delivering a
baby might increase the chances of a healthy delivery (especially if
they had just attended to a diseased patient)!
Each book in Lucents Diseases and Disorders series explores
a disease or disorder and the knowledge that has been accumulated (or discarded) by doctors through the years. Each book also
examines the tools used for pinpointing a diagnosis, as well as
the various means that are used to treat or cure a disease. Finally,
new ideas are presentedtechniques or medicines that may be
on the horizon.
Frustration and disappointment are still part of medicine, for
not every disease or condition can be cured or prevented. But the
limitations of knowledge are being pushed outward constantly;
the most difficult puzzles ever devised are finding challengers
every day.
Introduction
A Disease That Is
Often Ignored
F
Acne
Common Misconceptions
Ignorance about acne has led many people to believe common misconceptionsfor example, that a lack of cleanliness or eating sweets
can cause acne. These misconceptions make many people with acne
wrongly feel that they are somehow responsible for their condition. Misperceptions may also cause other people to treat people
with acne unsympathetically. An acne patient explains how her fathers belief in one such misconception affected her:
It was almost as if I had an enemy in the home as well as the
enemy of acne, because it was his ignorance of acne and his ignorance of my feelings, which was belittling. If he saw me eating chocolate Id be given that look. You know . . . you
shouldnt be eating and enjoying that . . . which, I think is fair
to say, is a common reaction from family and friends. 5
it is important that everyone learn more about acne. By understanding what causes acne, how it is treated, and how different behaviors affect the disease, people with acne will be better able to
cope. At the same time, learning about acne will help friends and
family members to provide more support for their loved ones.
Learning about acne will also help others become more sensitive
about the way they interact with people with acne.
Indeed, once Fred and his family learned more about acne, his
parents took him to the doctor, where he was given medicine that
helped get his acne under control. Today, Fred is a grown man with
his own family. In the years that have passed he has learned quite
a bit about acne, and so have his parents. When the grandkids
started breaking out, my parents insisted they be taken to the doctor right away, Fred explains. It took some time, but weve all
learned just how serious acne is. 6
Chapter 1
What Is Acne?
A
CNE IS A COMMON skin disease that affects tiny ducts in the skin
What Is Acne?
11
cles to the surface of the skin at the rate the sebum is produced. Instead, sebum becomes trapped in the follicles, where it mixes with
dead skin cells, forms sticky plugs that block the pores, and prevents sebum from reaching the surface of the skin. As a result,
the skin around the clogged follicles dries out. At the same time,
since not every follicle becomes clogged, excess oil that spills onto
the skin through unclogged follicles causes the skin to feel oily.
Clogged and infected hair follicles like this can cause sores, or acne lesions, to
form under the skin.
12
Acne
Infection occurs when bacteria enter a clogged hair follicle, causing the area
around the follicle to become swollen and painful.
Therefore, a person with acne may have dry skin around clogged
follicles and oily skin everywhere else.
Worse yet, without sebum to wash away bacteria on the skin,
bacteria grow and multiply around the clogged follicles. Eventually, bacteria get inside the clogged follicles, where they mix with
sebum and dead cells and cause an infection. This most commonly
occurs on the parts of the body that have the largest sebaceous
glands, such as the face, chest, neck, shoulders, upper back, and
buttocks. The result is the development of one type of acne lesion
known as a comedone.
What Is Acne?
13
14
Acne
What Is Acne?
15
Not surprisingly, pustules are larger than papules. They are often about the size of the tip of a persons little finger. Pustules are
red at the base, with a yellowish, pus-filled inner region. A man who
had pustules on his face, shoulders, and neck recalls: They were
big old welts filled with white poison and surrounded by red rings. 8
Although a pustules red base forms on the surface of the skin,
the pus-filled core is near, but still underneath, the skin. However,
as inflammation worsens and more pus is formed in the area, the
pus-filled core of a pustule begins to swell like a balloon. When
this happens, it is not uncommon for pustules to pop open and
spill pus onto the skin. A man recalls: In the morning before I went
to school, Id have big welts on my shoulders and neck. Sometimes
at school they would break without me even knowing. When I got
home Id have stains on my shirt. 9
Cysts
Just as worsening inflammation causes a pustule to expand upward through the skins surface, worsening inflammation also
causes pustules to expand downward. When this occurs, a cyst is
Papules like this are small, red bumps that form when a closed comedone bursts
and spreads infection to surrounding tissue.
16
Acne
formed. Cysts are packed with large amounts of pus that extend
deep below the skins surface. Due to swelling, cysts may be several centimeters in diameter. Most cysts are red or purple and extremely painful. Since cysts form when inflammation and infection
are the most severe, cysts are the most serious type of acne lesions.
Although people of any age can develop acne, teenagers are most commonly
affected by the disease.
People at Risk
Although almost everyone has an occasional whitehead or blackhead, certain groups are more likely to develop acne vulgaris and
cystic acne than others. These include adolescents, adult women,
people under stress, people taking certain medications, and people whose parents had acne.
Acne in Adolescents
Adolescents are the largest group at risk of developing acne. This
is because acne usually begins during puberty, when the body
starts producing androgen. Androgen production is usually at its
peak when people are between the ages of twelve and seventeen.
Therefore, more oil is produced in the hair follicles of adolescents
than in any other age group. As a result, experts estimate that more
than 85 percent of all adolescents between the ages of twelve and
seventeen develop some form of acne. This translates to more than
20 million teenagers in the United States. Moreover, although both
18
Acne
What Is Acne?
19
20
Acne
that stress directly causes acne, numerous studies have linked stress
and acne flare-ups. The reason for this link is that when the body
is under stress, it responds by producing hormones, including androgen and cortisol. Cortisol, like androgen, stimulates oil production. Therefore, people who are under stress are at risk of
developing acne or having their existing acne worsen. Moreover,
even though the production of stress hormones decreases as a person relaxes, stress-induced acne flare-ups often do not clear up until the inflammation heals. This may take a week or more.
Chu describes how stress affects his patients: I have looked after four women who have cancelled their weddings on at least one
occasion. Each time they neared their wedding day, stress levels
increased and their spots became so bad that they cancelled because they could not bear the thought of wedding photographs of
themselves covered with spots. 14
What Is Acne?
21
Genetics
Genetics also plays a role in determining who is at risk of developing acne. Experts agree that acne seems to run in families and
that there seems to be a direct link between the development of severe acne and familial patterns. Experts are unsure why this is so,
since an acne gene has not yet been discovered. However, a number of studies have shown that genetics does play a role in determining how likely a person is to develop acne. Various studies of
identical twins, for example, found in over 50 percent of all cases
that if one twin develops acne so does the other. Correspondingly,
other studies have shown similarities among parents and children
regarding the types of acne lesions, the severity of acne, and the
duration of acne. A patient with acne explains: I inherited it [acne]
from my mother, and shes always telling me that she had the exact same thing and that it will go away. I am mad that I inherited
it from her. 15
22
Acne
to form over the damaged area. The results are keloid scars, which
look like firm, shiny, flesh-colored lumps.
Acne scars that are caused by tissue loss occur when the body
is unable to completely rebuild damaged tissue. Often called depressed, ice-pick, or pitted scars, these scars look like the skin has
been pushed in, forming a soft depression with puckered edges.
Pitted scars can be quite small, or they can be over a centimeter
in diameter. Pitted scars are the most common type of acne scar
and are commonly found on the face, back, and shoulders.
Fortunately, not every person who has acne develops acne scars.
Doctors are unable to predict accurately whether or not a person
with acne will develop scars. However, in most cases, as the severity of a persons acne increases so does the amount of tissue damage. Since acne scars result from damaged tissue, individuals who
suffer the most tissue damage are most at risk of developing acne
scars. Generally, these are individuals with severe cases of acne.
What Is Acne?
23
Chapter 2
Diagnosis and
Treatment
A
25
26
Acne
A Common Goal
Because there are many differences in the severity and types of acne
lesions, there are a wide variety of acne treatment options. These
include over-the-counter medication people can purchase without
a doctors prescription as well as more powerful, doctor-prescribed
medications. Acne medication may be taken orally or applied directly onto the skin in the form of a topical treatment. Often, oral
and topical treatments are combined. Once acne outbreaks are eliminated, a special type of surgery known as skin dermabrasion can
lessen acne scars.
No matter what form of treatment is used, all acne treatments
share a common goal: to control the sequence of events that cause
acne outbreaks in order to prevent new outbreaks from occurring.
Experts agree that since there are so many different acne treatment
options available, most cases of acne outbreaks can be controlled.
Edmonton, Canada, dermatologist Don Groot explains: Weve got
acne by the tail now. If we catch it early, you can do wonders with
acne. Its not a difficult disease to treat anymore. 19
Topical Treatments
Some of the most popular and effective treatment options available for acne are topical treatments. Most commonly used to treat
cases of mild to moderate acne, topical treatments come in cream,
lotion, or gel form and on specially prepared pads. Those used to
treat the mildest cases of acne can be purchased without a doctors
prescription.
Salicylic Acid
Salicylic acid is a popular topical treatment that can be purchased
without a doctors prescription. Salicylic acid does not treat infection
or inflammation. Therefore, it is mainly used to treat comedones.
27
When salicylic acid is rubbed onto the skin, it penetrates the pores
and gets inside clogged hair follicles. Salicylic acid causes the dead
skin cells inside the follicles to dissolve. This allows oil trapped in
the follicles to reach the skin. Many patients report that treatment
with salicylic acid helps eliminate acne outbreaks. A patient explains:
I have blackheads on my back. I wipe my back with salicylic acid
wipes every night. It didnt help immediately, but after about a month,
I noticed a difference. I think its helping. 20
Benzoyl Peroxide
Benzoyl peroxide is another topical treatment that can be purchased
without a doctors prescription. In fact, it is the main ingredient in
most over-the-counter acne preparations. Used to treat mild inflammatory acne, benzoyl peroxide is available in different strengths.
It is often used with products that contain salicylic acid by patients
who have both comedones and mildly inflamed pustules.
Benzoyl peroxide is an oxidizing agent, meaning it releases oxygen. The bacteria that cause acne can only exist in an oxygen-free
environment, such as a clogged hair follicle. When benzoyl peroxide penetrates hair follicles and releases oxygen, acne-causing
bacteria are killed. This not only relieves existing infection but also
stops new pustules from forming. A young woman describes her
experience with benzoyl peroxide: After two and a half weeks I
was clearer than I had been since before puberty. . . . Using this benzoyl peroxide . . . has really changed the way I feel about myself
and my ability to take on the world. 21
28
Acne
29
Oral Medication
In addition to topical treatments, many people with moderate to
severe inflammatory acne take oral medication, either alone or in
combination with topical ointments. There are three main types of
oral medications used to treat acne. They are antibiotics, hormones,
and isotretinoin.
Antibiotics
Bacteria-fighting oral antibiotics such as tetracycline, erythromycin,
clindamycin, and doxycycline are often prescribed for people whose
acne does not respond to topical antibiotic treatment. Oral antibiotics are absorbed through the digestive system, into the bloodstream, and then into the skin and hair follicles. Here they kill
acne-causing bacteria and reduce inflammation. This helps stop
new acne lesions from forming and gives the skin a healthier appearance by lessening redness. However, most oral antibiotics are
absorbed into the bloodstream quickly. Consequently, they are eliminated from the body rapidly. Therefore, in order to maintain a constant level of bacteria-fighting medication in the bloodstream, oral
antibiotics must be taken frequently for an extended period of time.
Indeed, some people with acne take antibiotics two or three times
each day for six months to a year. Moreover, once treatment with
oral antibiotics is stopped, unchecked bacteria often cause new acne
30
Acne
Hormones
For many teenage girls as well as women with adult-onset acne,
treatment with female sex hormones such as estrogen offers another treatment option. Usually taken in the form of low-dose birth
control pills, hormonal therapy increases the level of female hormones in a womans bloodstream. This reduces or blocks the production of androgen. Once androgen production is decreased,
sebum production is decreased as well. The result is decreased acne
outbreaks. A woman describes her experience with hormone therapy: I was surprised when my doctor prescribed birth control pills
to clear up my skin. It sounded strange. But I was at the end of my
rope as far as my skin was concerned. I tried just about everything
else, so I decided to give birth control pills a shot. I am so happy
with the results. My skin hasnt looked this good in years. 24
Isotretinoin
For patients with severe cystic acne or for patients with moderate
inflammatory acne that has proven to be resistant to oral antibiotics,
isotretinoin is the most effective acne treatment available. In fact, it
is the only medication that effectively controls severe cystic acne.
Commonly sold under the brand name Accutane, isotretinoin is a
vitamin A derivative that is administered in pill form.
Isotretinoin is an extremely powerful drug that stops all the
changes in the skin that cause acne. It kills bacteria and reduces in-
31
For patients like this man with severe cystic acne, the powerful drug isotretinoin
has proven to be the most effective treatment available.
32
Acne
patients may begin a second cycle of isotretinoin treatment. A patient describes her experience:
After a few weeks on Accutane, my breakouts stopped dead in
their tracks. I experienced no breakouts whatsoever for the remainder of the time I took the prescription. People with fantastic skin would come up to me and say, I wish I had your skin.
It was pretty incredible. However . . . I was not one of the lucky
ones. Although my skin has been more manageable since Accutane, I have experienced serious breakouts since ending my
cycle. Even so, I remain very thankful that I took it. I would describe my acne now as light to moderate thanks to Accutane, and
with my current regime [use of topical treatments] I stay clear. 26
33
34
Acne
35
36
Acne
An executive for the drug company Hoffman-La Roche speaks about the
psychological effects of Accutane, a drug linked to two patient suicides.
Bart Stupaks son. According to the congressman, The side effects of Accutane are not worth it. 30 In fact, the congressman
would like to see to the drug banned until further studies into
its psychiatric effects are completed.
Although the drug has not been banned, due to these and other
cases it is illegal for doctors to administer the drug until patients
37
Chapter 3
Alternative and
Complementary
Treatments
S
INCE ACNE MEDICATION can have harmful side effects, many people with acne explore alternative treatments in an effort to find
safer treatment options. Moreover, some people with acne use alternative treatments to reduce stress, which, when left unchecked, encourages acne outbreaks. Indeed, the use of alternative treatments has
grown widely among acne patients, with many reporting positive results. An acne patient explains why she sought alternative treatment:
39
40
Acne
41
An acne patient consults with an herbalist about herbal treatments. Herbs most
commonly prescribed for acne act to balance the patients hormone levels.
fect of androgen. Although studies into the effectiveness of hormonebalancing herbs on acne are limited, many experts think herbs containing phytoestrogen can help women with hormonal acne. Stanley
W. Beyrle, a naturopathic doctor at the Kansas Clinic of Traditional
Medicine in Wichita, explains:
42
Acne
43
44
Acne
A biologist hangs seaweed to dry. Studies suggest that topical creams made
with seaweed have a powerful effect on acne-causing bacteria.
Seaweed, too, has powerful antibacterial properties. First discovered in 2001 in France as a treatment for acne, topical treatments
made from seaweed are quite potent. According to a November
2001 report in YM.com, the online edition of YM magazine, seaweed has such a powerful effect on acne-causing bacteria that it
takes only two pounds of seaweed to make a ton of acne spot
cream.
Other external herbal remedies use herbs such as agrimony, burdock, cloves, lavender, licorice root, and white willow, to name just
a few, because of their anti-inflammatory, antiseptic, and porecleansing properties. In fact, white willow contains a natural form
of salicylic acid. Often these herbs are combined with minerals
45
such as zinc, which aid in the healing of skin tissue, and are applied on the skin systematically in the form of daily cleansers and
healing balms and weekly facial masks. A woman whose grandson used such a system describes how it helped him: My grandson was teased by the horrible acne covering his face. Now there
is no sign he ever had acne. Within days of starting your system
[one manufacturers herbal skin care regime] his acne turned to
small scabs and then healed without scars. It also worked wonders on his chest and back. 37
Ear Acupuncture
Acupuncture is another alternative treatment that is applied to the
skin. Developed thousands of years ago in China, acupuncture is
based on the concept that everyone has an energy known as chi
flowing through their bodies. When this energy flow is blocked,
illness occurs. In order to unblock this energy flow, acupuncturists insert small needles into specific points on the body. Acupuncturists think that some of these points, especially those found in
the ear, control energy flow to the face, where acne is likely to occur. Therefore, inserting needles into the ear stimulates the flow
of energy to the face. Once the flow is restored, blood circulation
to the face improves, bringing increased oxygen, collagen, nutrients, and infection-fighting chemicals to acne-affected areas. In
addition, acupuncturists believe that acupuncture treatment balances hormone production.
Despite the lack of evidence proving that chi exists, a number
of studies have shown acupuncture to be an effective treatment
for acne. For example, one 1989 Chinese study reported in the Journal of Traditional Chinese Medicine treated eighty patients with moderate to severe acne with ear acupuncture every other day for a
total of sixteen treatments. Seventy-seven percent of the patients
were reported completely cured, while the skin of 14 percent
showed a marked improvement. A 1990 Chinese study reported
similar results.
Another study conducted at the University of Heidelberg, Germany, in 1992 investigated the effects of ear acupuncture on women
with hormonal acne. In this study, half the subjects were treated
46
Acne
48
Acne
or phrase until they feel calm and all stressful thoughts are removed
from their minds. Research has shown that during meditation, the
production of cortisol decreases and remains lowered when individuals practice meditation often. As a result, sebum production
and acne outbreaks are reduced.
Guided imagery is a type of meditation in which people center
their thoughts on relaxing and healing their bodies. For example,
when faced with a stressful situation, many acne patients use
guided imagery to imagine themselves in a tranquil environment,
such as a forest or beach, where they feel relaxed and happy. At
the same time, they envision their complexion without acne. The
feelings evoked during guided imagery help people with acne
lower their stress levels and strengthen their resolve to heal. An
acne patient explains:
I light scented candles, pop in a CD, and imagine myself walking on the beach in Mazatlan [a beach resort in Mexico]. I think
about how good I feel, how peaceful the beach is, and how the
sun warms my face and heals my skin. I imagine the sun cleansing and clearing my skin from the outside, and my own body
doing it from the inside. In my mind, my skin is perfect and
Im beautiful. When Im done, Im relaxed and more confident,
too. 39
Yoga
Practicing yoga, a form of exercise that originated in ancient India,
is another way people with acne relieve stress. Yoga exercises involve slow, controlled stretching and breathing, which relax the
body while lowering cortisol levels. Because yoga is a form of exercise, it also improves blood circulation. Improved circulation
brings more oxygen and bacteria-fighting cells to areas affected by
acne. Yoga practioners say that specific yoga postures such as the
lion, standing and seated sun, and cobra have distinct healing effects on the body, including relaxation, internal cleansing, and releasing blocked energy. Although there is little proof that yoga does
all these things, it is so popular for reducing stress that many physicians recommend it to their patients.
49
Aromatherapy
Aromatherapy is another popular alternative treatment for reducing stress. It is based on the theory that scent influences the
By helping to alleviate stress, yoga can help improve the complexion of
acne sufferers.
50
Acne
way people feel. Aromatherapy uses candles scented with essential oils extracted from plants. It also uses aroma lamps and diffusers that spray the oil into the air in a mist. These oils are derived
from plants such as jasmine, chamomile, vanilla, lemon balm, and
lavender and are believed to have calming properties. Indeed, people report feeling calmer and less stressed after inhaling them.
A man shops for herbal remedies. Although some people consider alternative
treatments to be safer than conventional treatments, such therapies still pose
health risks.
51
Studies into the effectiveness of aromatherapy are limited. However, neurologists at the Smell and Taste Treatment and Research
Foundation in Chicago have been conducting research on aromatherapy for seventeen years. Their findings support the theory
that scent has a powerful effect on an individuals mood and behavior. The reason for this, they say, is that inhaling certain scents
alters brain waves and affects the pleasure center of the brain.
One study in particular investigated how aromatherapy can
change an individuals mood. In this study, which was conducted
in 2002 at the University of Southampton School of Medicine in
England, fifteen extremely nervous psychiatric patients inhaled
lavender oil for two hours a day every other day for ten days. On
these days, 60 percent of the patients were reported to be calmer
and happier. On the alternate days, however, when the patients
inhaled a mist of pure water, there was no change in their mood.
Many acne patients report that aromatherapy has a similar effect on their response to stress. A former acne patient explains:
Even now, I still get an occasional acne breakout. It seems to happen most when Im under stress at work. One of the ways I handle stress is by filling my oil lamp with lemon balm, and lighting
it up right beside my hot tub. The combination of the warm bubbling water and the scented oil drains away my worries. No worries means no frown lines, and no pimples. 40
52
Acne
dosages, are too strong for patients. But many people are unaware
of this. They assume that because herbs are natural and have been
used for thousands of years, these products are safe. However, high
doses of certain herbs can cause nausea, stroke, heart problems, and
hypersensitive skin. In addition, patients are just as likely to have
an allergic reaction to herbs as to conventional medications. Moreover, scientists do not know what the long-term effect is of treatment with these products. This is a special problem when it comes
to treatment with phytoestrogen. As yet, scientists do not know
whether long-term phytoestrogen treatment, like conventional hormonal therapy, is linked to cancer and heart disease.
In addition, due to the lack of regulation, herbal products may
contain herbs, chemicals, and drugs that are not listed on the label. For example, a 1999 random sampling in London, England, of
eleven different herbal creams used to treat acne found that eight
of the eleven products tested contained dexamethasone, a powerful steroid drug that was not listed on the labels. A 2003 article
in SKINmed, a journal for dermatologists, explains:
Guidelines concerning correct identification of the herb, the labeling of active ingredients, and establishment of purity are
nonexistent. Lack of quality control too often leads to misidentification and contamination with toxic ingredients including
pesticides, chemicals, heavy metals, and hidden drugs with their
resultant ill effects. . . . From the reports of adverse reactions, it
is becoming obvious that a history of traditional use is not a guarantee of safety. 41
Chapter 4
54
Acne
Washing the face regularly with facial cleansers specially made for acne sufferers
can help improve a persons complexion.
55
Not only do acne patients use gentle soaps, they also use disposable washing pads or their fingers rather than a washcloth or
loofah to cleanse acne-prone areas. The reason for this is that when
a washcloth or loofah is used more than one time, it can trap and
spread bacteria. In addition, washcloths and loofahs made from
scratchy fabrics can irritate acne lesions and worsen inflammation.
For the same reasons, acne patients use a fresh, clean, soft towel
to gently pat, rather than rub, their skin dry once they are finished
cleansing. Then, once acne patients have cleaned and dried their
face, they can apply topical treatment. An acne patient recalls:
When I first started breaking out, I scrubbed my face all the time
with the same washcloth that hung in my bathroom for weeks,
and the same soap that I scrubbed my hands with after I worked
on my truck. Then I rubbed my face dry with the same towel I
used on my hands. The only thing all that cleaning did was turn
my blackheads into pusy red zits. Once the dermatologist
straightened me out, I stopped using all that stuff, and my skin
started to improve right away. 43
56
Acne
wash these areas with a gentle soap after you have rinsed the conditioner out of your hair. I know this can be a problem especially
for girls with long hair; the conditioner goes down your back and
leaves this nice zit-causing film that water doesnt wash off. 44
Drinking at least half of ones body weight in ounces of water each day
prevents toxins and impurities from building up in the skin.
when people do not get adequate sleep. Since excess cortisol leads
to increased sebum production, getting plenty of sleep keeps cortisol levels low and thus helps control acne.
In addition, a 2003 study conducted by the Endocrine Society
in Chevy Chase, Maryland, found that a loss of just two hours of
sleep per week increases the bodys production of inflammationcausing chemicals by 60 percent. The result is a worsening of inflammatory acne. A former acne patient describes how lack of sleep
affected his skin: When I pulled an all-nighter my face erupted
like a volcano; and not with little blackheads either, but with big
red welts. As a teenager with acne I needed to get at least eight
hours of sleep a night. 46
While getting adequate sleep is important, acne outbreaks can
be exacerbated if the bedding on which acne patients sleep is not
58
Acne
changed often. When people sleep, oil, bacteria, and dead skin cells
rub off their skin and accumulate on their bedding. The bedding
absorbs these items, which then find their way back onto the skin,
clogging the pores and causing new acne outbreaks. Therefore, it
is important that people with acne change their sheets and pillowcases often. An acne patients explains: I have found that changing my bedding, especially my pillowcase, every few days has
helped my skin stay clear. 47
Exercise
Exercise is another good health habit that helps improve acne
symptoms. Besides being good for a persons overall health, exercise causes the body to release endorphins, natural chemicals
Regular exercise releases endorphins into the body that help relieve stress and
stress-induced acne.
59
60
Acne
the pores, where it can block hair follicles and cause irritation, inflammation, and worsening of acne symptoms.
Foods high in iodine include iodized salt, shellfish, and milk. In
fact, a liter of milk contains anywhere from 450 to 1,000 micrograms
of iodine, which gets into the milk through milking equipment and
medication given to cows. According to Dr. James Fulton, the head
of the Acne Research Institute in Newport Beach, California, In
some who are acne-prone, Id say 1,000 micrograms or 1 milligram
of iodine a day could be a problem. 48 Therefore, in order to reduce
acne outbreaks, many people with acne avoid foods rich in iodine.
Acne sufferers who touch their faces with their hands can exacerbate their
acne because even clean hands transmit bacteria.
62
Acne
to stop either. But I dont want new zits all over my face, so I really watch myself. 50
63
is not clean, it can spread bacteria and oil. If it is not sharp, it can
irritate the skin and cause a razor burn, which makes the skin appear redder than usual.
In particular, shaving with a dry razor causes problems. Washing the face before shaving softens the skin and beard. Conversely,
when the face is dry, the shavers skin and beard are tough. Therefore, the shaver must apply more pressure to the razor in order
to remove facial hair. This irritates the skin and leads to razor burn.
Dull or dry razors can cut acne lesions and spread bacteria. Men with acne
should use sharp, wet razors when shaving.
64
Acne
65
tane, antibiotics, or retinoids, exposure to sunlight can be dangerous. Many acne medicines cause photosensitivity, which makes
the skin burn easily when it is exposed to sunlight. Therefore, many
people with acne avoid exposure to sunlight.
Staying Active
Another way acne patients deal with emotional issues is by staying active. Getting involved in activities that are fun and that focus
on others helps people with acne to forget about their appearance
while raising their self-esteem. Supporting a cause, joining a club
or church group, or doing volunteer work are a few of the ways
people with acne stay active and raise their self-esteem in the
process. A former acne patient explains:
Being a teenager with pimples, that was bad. I knew I wasnt
popular. I knew I wasnt attractive to girls. There was a lot of
anger and humiliation. I wanted to avoid social activities and
stay home and hide. But I went out anyway. I had to get over
myself. I had to put myself out there, pimples and all. One of
the things I did was volunteer at the animal shelter. The animals didnt care how I looked. They licked my face, welts and
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Acne
Participating in activities like this church group picnic can raise the self-esteem
of acne sufferers and help them deal with emotional issues.
Chapter 5
INCE ACNE TREATMENTS are not always effective and can cause
serious side effects, scientists are focusing their research on developing safer and more effective acne treatments. In an effort to
do this, they are concentrating on learning more about hormonal
changes and the bacteria that are linked to acne. At the same time,
scientists are developing less invasive treatments to minimize acne
scars.
68
Acne
69
mation, scientists hope to develop a vaccine made of microorganisms known as antigens that would attack the DNA pairs that form
Propionibacterium acnes. This attack, scientists theorize, would so
weaken the DNA pairs that they would separate. This would upset
the order of the DNA chain that forms Propionibacterium acnes,
killing or at least weakening the bacterium.
Although this vaccine would not stop a persons hair follicles from
becoming clogged, thus preventing comedones from developing, it
70
Acne
71
72
Acne
73
onibacterium acnes. Once such a bacteriophage is identified, scientists hope to use it in a topical treatment that could be rubbed
directly on infected acne lesions, killing the underlying bacteria
on contact. Although scientists have discovered a bacteriophage
that attacks the streptococcus bacterium that causes strep throat
and the flesh-eating disease, they have not yet discovered one that
targets Propionibacterium acnes. Therefore, research is ongoing.
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Acne
75
skin and the oil glands. This makes wrinkles and acne scars appear smaller and decreases the flow of oil and the development of
acne lesions. A number of studies have reported treatment with
radio waves to be effective in eliminating acne lesions and making
acne scars less visible. Therefore, the FDA approved the use of ThermaCool TC, one type of radio wave acne treatment, in 2003.
77
78
Acne
end of the last treatment all the subjects showed a 40 percent improvement in the appearance of their acne scars. Improvement
was measured by how much each pitted acne scar was raised
after treatment.
YAG treatment is reported to be relatively painless. Patients
say it feels like a rubber band being snapped across their skin.
More importantly, results from YAG treatment are reported to
last for years, and the treatment does not create any visible
wounds or redness of the skin. In addition, because it does not
vaporize underlying skin cells, it does not lighten the skin. Dr.
Mitchel Goldman, who conducted the 2001 San Diego study, explains:
YAG laser is an excellent method for treating acne scars because
it works for all skin typesfrom very dark to very lightand
with no down time. Until now, many of the other acne scar treatments produced a wound that may have required weeks to heal.
Since this new laser therapy is non-invasive, the patient does not
require anesthesia and the procedure is not a painful one. 63
79
A technician monitors a YAG laser. Treatment with YAG lasers is less invasive
and requires less recovery time than CO2 laser treatment.
part of the scar, minimizing its appearance. In order to fill in multiple or deeply pitted acne scars, multiple syringes are usually used.
However, over time fat starts to break down and some of the transplanted fat eventually is reabsorbed into the skin. This means that
in about six to eighteen months, acne scars will once again reappear, and the procedure must be repeated.
Since repeated autologous fat transfers can be uncomfortable,
scientists are experimenting with substances other than a patients
own body fat to use in this process. So far, they have developed a
way to substitute bovine collagen, or collagen extracted from cows,
for a patients own fat. However, since the immune system identifies the bovine collagen as a foreign object, it usually is destroyed
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Acne
by the immune system in three to six months. Moreover, many patients have an allergic reaction to bovine collagen. Therefore, scientists are continuing to work on developing a long-lasting
substance that will not cause any side effects. This includes experiments with the plastic Gore-Tex, which so far scientists have
been unable to produce in injectable form.
Scientists have also been experimenting with skin tissue derived
from human sources. Sheets of skin are donated to tissue banks
in the same way as organs such as livers or hearts are donated.
Then, the sheets of skin undergo a process in which they are turned
into an injectable semiliquid or powdered form, which is administered in the same manner as autologous fat. Since skin naturally
regenerates, the newly injected skin quickly repopulates the injected area, causing depressed acne scars to fill in.
This procedure has been available to patients since 2000. At first,
scientists thought it would offer patients a permanent solution to
minimizing acne scars. However, transferred skin tissue, like bovine
collagen, is targeted by the immune system as a foreign object and
is broken down by the immune system in three to six months.
Therefore, scientists are still working on perfecting this procedure
in order to make it longer lasting.
Although scientists have not yet discovered a way to permanently erase acne scars, there is optimism that such a discovery is
on the horizon. There are many ongoing studies investigating hormonal changes and Propionibacterium acnes, and with the development of new, safer, more effective, and less invasive treatments,
the future looks bright for people with acne. Indeed, a cure may be
found in the future, but for now, new treatments give people with
acne hope.
Notes
Introduction: A Disease That Is Often Ignored
1. Fred [pseud.], interview with the author, Dallas, Texas, May 15,
2003.
2. Quoted in Tamar Nordenberg, Battling Blemishes and Beyond,
Discovery Health Channel. www.health.discovery.com.
3. Fred, interview.
4. Quoted in Linda Papadopoulous and Carl Walker, Understanding Skin Problems. West Sussex, England: Wiley, 2003, p. 16.
5. Quoted in Anthony C. Chu and Anne Lovell, The Good Skin Doctor. London: HarperCollins, 1999, p. 129.
6. Fred, interview.
Chapter 1: What Is Acne?
7. Mike [pseud.], interview with the author, Dallas, Texas, May 16,
2003.
8. Fred, interview.
9. Fred, interview.
10. Fred, interview.
11. Fred, interview.
12. Chu and Lovell, The Good Skin Doctor, p. 15.
13. Quoted in Acne.org, Success Stories. www.acne.org.
14. Chu and Lovell, The Good Skin Doctor, p. 81.
15. Quoted in American Academy of Dermatology, The Social Impact of Acne. www.derm-infonet.com.
16. Quoted in Acne Support Group, Top Ten Problems. www.stop
spots.org.
17. Quoted in Acne.org, Success Stories.
18. Fred, interview.
81
82
Acne
Notes
83
Glossary
Accutane: A popular drug used to treat severe acne. It is also
known as isotretinoin.
acne: A common skin disease.
androgen: A male sex hormone produced by both men and women.
bacteriophage: A virus that is deadly to bacteria but harmless to
humans.
benzoyl peroxide: A topical treatment for acne.
collagen: A natural substance that helps the skin regenerate.
comedones: Acne lesions that appear in the form of whiteheads
and blackheads.
cysts: Large, inflamed acne lesions occurring deep under the skin.
dermatologist: A doctor who specializes in diseases of the skin.
estrogen: A female sex hormone.
follicles: Tiny ducts in the skin where hair grows.
genome: All the genes in an organism.
heat-shock protein: Cellular protein that stimulates inflammation.
hormones: A variety of chemicals produced by the body to regulate different body functions.
ice-pick or pitted scars: Acne scars that are caused by tissue loss.
inflammation: Redness, swelling, and heat produced by the immune system to combat infection.
isotretinoin: A powerful drug derived from vitamin A that is used
to treat severe acne.
keloid scars: Acne scars that form as a result of increased tissue
formation.
noncomedogenic: Cosmetics that do not contain oil and will not
clog pores.
papules: Red, mildly inflamed acne lesions.
84
Glossary
85
Organizations to Contact
American Academy of Dermatology
PO Box 4014
Schaumburg, IL 60168-4014
(888) 462-3376
fax: (847) 330-0050
www.aad.org
The American Academy of Dermatology publishes brochures and
fact sheets on acne and offers referrals to dermatologists and information on every aspect of acne.
Association for Dermatologic Surgery
5550 Meadowbrook Dr., Suite 120
Rolling Meadows, IL 60008
(847) 956-0900
www.aboutskinsurgery.com
The Association for Dermatologic Surgery offers information on
skin surgery, including surgery for acne scars, and news updates
on the latest research developments in skin surgery.
National Center for Complementary and Alternative
Medicine Clearinghouse
PO Box 8218
Silver Spring, MD 20907-8218
(888) 644-6226
http://altmed.od.nih.gov
This organization provides information and conducts research on
the effectiveness of alternative treatments.
86
Organizations to Contact
87
Works Consulted
Books
Bobbi Brown and Sally Wadyka, Beauty Evolution. New York: HarperResource, 2002. Beauty experts team up to give skin care tips for
women of all ages.
Anthony C. Chu and Anne Lovell, The Good Skin Doctor. London:
HarperCollins, 1999. A dermatologist and an advice columnist
team up to discuss the different types of acne, why it occurs, and
different conventional and alternative treatments.
Gale Maleskey, Natures Medicines. Emmaus, PA: Rodale Press, 1999.
Different herbs, what they do, and what illnesses they treat are
discussed in detail.
Linda Papadopoulous and Carl Walker, Understanding Skin Problems.
West Sussex, England: Wiley, 2003. Provides information and advice on living with different skin conditions, including acne.
Periodicals
Anjana Ahuja, Could a Jab Cure Teenage Spots? Times (London),
November 5, 2001.
Katherine Hobson, Mind Versus Face, U.S. News & World Report,
April 1, 2002.
In Style, Beauty Talk, July 2003.
Joseph A. Witkowski and Lawrence Charles Parish, Dermatologic
Manifestations of Complementary Therapy, SKINmed, 2003.
Internet Sources
Acne Net, Acne Net Update. www.skincarephysicians.com.
Acne.org, Accutane. www.acne.org.
, Success Stories. www.acne.org.
Acne Support Group, Top Ten Problems. www.stopspots.org.
Australian, Bleeding Misery of the Boy Cursed by a Common Cure,
January 18, 2003. http://searchepnet.com.
89
90
Acne
Index
Accutane. See isotretinoin
acne grading scale, 2426
Acne Research Institute, 60
Acne Support Group, 22, 46
acne vulgaris, 1618
acupuncture, 4547
adolescents, 1718
American Academy of
Dermatology, 2526, 29
androgen, 10, 1721, 30, 41
antigens, 6970
aromatherapy, 4951
Australian (newspaper), 34
autologous fat transfer, 7879
bacteriophage, 7273
benzoyl peroxide, 27, 30, 38
Beyrle, Stanley W., 4142
birth control pills, 2021, 30, 34
blackheads, 1314, 1617, 24
Brown, Bobbi, 62
Central Hospital (Hong
Kong), 43
characteristics, 1013
chi, 45
Chu, Anthony C., 18, 20, 3132
Clearlight, 74
clindamycin, 29, 73
collagen, 2022, 29, 7780
92
exercise, 5859
Farrar, Mark, 70
follicles, 1013
Food and Drug
Administration (FDA), 35,
37, 39, 70, 7475
Fulton, James, 60
genetics, 21
Gillis, Steven, 70
Goldman, Mitchel, 78
Gore-Tex, 80
Groot, Don, 26
guided imagery, 4748
health habits
activity and, 60, 6566
bedding and, 5758
squeezing lesions and, 60
touching the face and, 6162
water consumption and, 56
see also hygiene
heat-shock proteins, 7071
herbs, 4044, 5152
HoffmanLa Roche, 36
hormones
acne treatments and, 29
acupuncture treatments
and, 45
herbs and, 4142
imbalances of, 18
medication, effects on,
2021
therapy and, 2930, 34,
4042, 46
water consumption and, 56
hygiene
bedding and, 5758
shampooing and, 5556
Acne
93
Index
94
ThermaCool TC, 75
treatments
complimentary, 40
ear acupuncture and, 4546
heat and, 7475
herbal, 4045
menstrual cycles and, 68
side effects of, 3233, 5152
stress-relieving, 4651
topical, 2628, 4345, 55,
7374
types of, 3839
vitamins and minerals and,
4243, 45, 51
see also health habits;
hormones; medications
University of California, 77
University of Chicago Medical
Center, 56
University of Heidelberg, 45
University of Leeds, 70, 73
University of Southampton
School of Medicine, 51
Acne
vaccines, 6871
vitamin A, 2930
vitamin B5, 4243, 51
water, 56
Weston Park Hospital, 46
whiteheads, 1317, 24
women
antibiotics, side effects and,
33
ear acupuncture and,
4546
herbal treatments and,
4042
hormones and, 1820
isotretinoin and, 37
menstrual cycles and, 67
YAG, 7779
YM (magazine), 44
yoga, 4849
zinc, 38, 45, 72
Zindacellin, 73
Picture Credits
Cover photo: Lou Chardonnay/CORBIS
John Bavosi/SPL/Photo Researchers, 11, 12
CORBIS, 19
David Gray/Reuters/Landov, 50
Geoff Lane/CSIRO/SPL/Photo Researchers, 76
Lawrence Livermore National Laboratory/SPL/Photo Researchers,
79
Dr. Kari Lounatamaa/SPL/Photo Researchers, 69
Dr. P. Marazzi/SPL/Photo Researchers, 15, 20, 31
Maximillian Stock LTD/SPL/Photo Researchers, 72
NASA/SPL/Photo Researchers, 71
Ulrich Perrey/DPA/Landov, 44
PhotoDisc, 17, 28, 33, 39, 41, 47, 49, 54, 57, 58, 61, 63
Patrick Pleul/DPA/Landov, 66
Reuters NewMedia Inc./CORBIS, 36
St. Bartholomews Hospital/SPL/Photo Researchers, 7
Steve Zmina, 25, 27
95
96